甲状腺全切及近全切术中甲状旁腺原位保护的临床研究  

Clinical Study of in Situ Protection of Parathyroid Glands During Total Thyroidectomy and Near Total Thyroidectomy

作　　者：许立生[1] 王水 赵志泓[1] 王坤[1] XU Li-sheng;WANG Shui;HAO Zhi-hong;WANG Kun(Department of Nail and Breast Surgery,Afiliated Hospital of Jiangsu University,Nanjing,Jiangsu Province,210000 China;Breast Center,First Affiliated Hoepital of Nanjing Medical University,Nanjing,Jiangsu Province,210000 China)

机构地区：[1]江苏大学附属医院甲乳外科,江苏南京210000 [2]南京医科大学第一附属医院乳腺中心,江苏南京210000

出　　处：《中外医疗》2020年第10期69-72,共4页China & Foreign Medical Treatment

摘　　要：目的为了提高甲状腺全切手术及近全切手术患者的安全性,在术中积极应用甲状旁腺原位保护,分析患者的临床效果。方法方便选取江苏大学附属医院甲乳外科临床接收并实施甲状腺全切手术及甲状腺近全切手术治疗的88例患者为该文的研究对象,纳入时间范围是2017年1月-2018年1月,根据术中是否显露及保护甲状旁腺的情况将88例患者分作A组(n=44例,术中未显露甲状旁腺)与B组(n=44,术中显露及保护甲状旁腺),对比两组甲状腺手术患者的临床疗效。结果①A组患者手术时长明显短于B组(P<0.05)。②B组患者手术后1 d与7 d的PTH水平与血清钙水平均较A组高(P<0.05)。③手术后1 d、7 d,B组的QOL评分均较A组高(P<0.05)。④A组术后发生甲旁减、喉返神经受损、低钙血症的几率依次是18.18%、9.09%、22.73%,均依次高于B组的2.27%(χ~2=6.065,P=0.014)、0.00%(χ~2=4.190,P=0.041)、4.55%(χ~2=6.175,P=0.013),对比差异有统计学意义(P<0.05)。结论对甲状腺全切手术及近全切术中实施甲状旁腺原位保护,不仅能维持良好的PTH水平与血清钙水平,而且还能有效减少术后发生甲旁减、低钙血症等并发症的风险,可保障患者的生活质量。Objective In order to improve the safety of patients undergoing total thyroidectomy and near total resection,the in situ protection of parathyroid glands was actively applied during the operation to analyze the clinical effects of the patients. Methods Eighty-eight patients who underwent clinical holologic surgery and performed thyroidectomy and thyroidectomy were conveniently selected in the department of breast surgery,Jiangsu university hospital. The time range was from January 2017 to January 2018. Whether the presence or absence of parathyroid glands was identified was divided into group A(n=44,no parathyroid gland was found) and group B(n=44,intraoperative display and protection of parathyroid glands). Compare the clinical efficacy of two groups of thyroid surgery patients. Results 1.The length of operation in group A was significantly shorter than that in group B(P<0.05). 2.The PTH level and serum calcium level of patients in group B were higher than those in group A at 1 d and 7 d after operation(P<0.05). 3.The QOL scores of group B were higher than those of group A at 1 d and 7 d after operation,P<0.05. 4.The incidence of hypoparathyroidism,recurrent laryngeal nerve injury and hypocalcemia in group A was 18.18%,9.09%,and 22.73%,respectively,which were higher than 2.27%(χ~2=6.065,P =0.014),0.00%(χ~2=4.190,P =0.041),4.55%(χ~2=6.175,P =0.013) in group B. There was A difference significant statistical in the comparison(P<0.05). Conclusion In situ protection of parathyroid gland in total thyroidectomy and near total resection can not only maintain good PTH levels and serum calcium levels,but also effectively reduce postoperative hypoparathyroidism,hypocalcemia,etc. The risk of complications can guarantee the quality of life of patients.

关 键 词：甲状腺手术 甲状旁腺 显露 原位保护 临床研究 

分 类 号：R4[医药卫生—临床医学]